Dr. Elizabeth Nabel, president of Boston’s Brigham and Women’s Hospital and one of the nation’s most prominent medical executives, was part of a National Football League effort to “steer funding” for a landmark concussion study away from a group of respected brain researchers, according to a congressional committee report that was sharply critical of the league.
The report found that the NFL “inappropriately attempted to influence” the National Institutes of Health’s grant selection process.
Nabel, who also serves as the NFL’s chief health and medical advisor, told STAT she “had no intention of influencing” the NIH process. “I made my neutrality quite clear,” she said in a statement.
Released on Monday, the report was written by the Democratic staff of the House Committee on Energy and Commerce.
It cited a series of communications between NFL representatives, including Nabel, and officials of the NIH, and a foundation that accepts gifts from private donors to support NIH research. The discussions began after the NIH decided last year to award a $16 million grant to a research team led by Dr. Robert Stern of Boston University — but before the award was publicly announced.
The money for the grant was to come from a donation pledged by the NFL to the Foundation for the National Institutes of Health, and league officials say they were concerned about aspects of Stern’s group and the proposed study.
Research by Stern’s team and BU colleagues has helped establish a link between football and chronic traumatic encephalopathy, long-term brain damage that’s been observed in a growing number of athletes, including former NFL players, who suffered repeated head injuries.
Nabel, who knows the NIH well from her 10 years working as a high-level manager in the agency, sent two emails to Dr. Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke, according to the report. That’s the NIH branch that was awarding the grant.
In one email on June 23, 2015, she wrote, “I am taking a neutral stance here,” while noting a concern about a potential conflict of interest: members of the NIH grant review panel had coauthored papers with two researchers that she had heard might be receiving the grant — Dr. Ann McKee and Dr. Robert Cantu of BU.
Later that day, she wrote Koroshetz that “a Dr. Stern, who may also be with this group, has filed independent testimony in the NFL/Players Association settlement.”
Indeed, Stern was critical of how the settlement would be administered, pointing out flaws with the neuropsychological tests that the league proposed using to determine how to compensate injured players.
“I hope this group is able to approach their research in an unbiased manner,” Nabel’s email continued, the report says.
Nabel sent Stern’s testimony to Koroshetz, according to the report.
“My sole objective,” Nabel said in her statement, was to ask her former NIH colleagues to “ensure there were no conflicts of interest among grant applicants.”
The NIH found no conflicts involving the grant review panel and stuck with its decision to award the grant to the Stern group. It ended up using internal funds, not the NFL money, to pay for the grant.
The NIH told STAT it agrees with the “characterization of events in the report.”
The committee staff declined to provide copies of Nabel’s emails to STAT. Nabel, director of the National Heart, Lung, and Blood Institute from 2005-2009, declined to be interviewed, but a Brigham spokeswoman answered questions posed by STAT in writing.
She said Nabel contacted Dr. Thomas Insel, director of the National Institute of Mental Health, soon after becoming an NFL adviser in February 2015, to propose a collaboration “to explore the interface between head trauma and behavioral health.” That led to followup discussions with other NIH officials, including Koroshetz.
“Months later, when representatives from the NFL’s Head, Neck, and Spine Committee expressed concerns about potential conflicts of interest among grant applicants, Dr. Nabel contacted Dr. Koroshetz to bring the concerns to his attention,” the spokeswoman said. “At no time did she raise, nor did they discuss, allocation of funds.”
The report says that in June 2015, Koroshetz proposed funding additional research, in a call with other NFL representatives, to “address the NFL’s concerns.”
Nabel was also involved in discussions with Koroshetz about funding additional studies, according to her spokeswoman. “She was working through the appropriate channels to ensure this important research be conducted in a way that would yield the best possible science,” the spokeswoman said.
According to a letter sent this March by Democratic members of the House committee to NFL Commissioner Roger Goodell, Nabel later wrote in an email to the FNIH and an NFL official last August that a collaboration of three research groups “would be ideal and would dilute the voice of a more marginal group.”
Other NFL representatives contacted both Koroshetz and the FNIH, which was to manage communication between the NFL and NIH regarding this research project, according to the committee report. Those representatives included Dr. Richard Ellenbogen, cochairman of the league’s Head, Neck, and Spine Committee.
The NFL said in a statement that “concerns were raised for review and consideration through the appropriate channels.”
Jeff Miller, the NFL’s executive vice president of health and safety, told the congressional investigators that Nabel and Ellenbogen believed they raised their concerns “in the most appropriate way, and this back-and-forth over the grants process was hardly unusual,” according to the report.
Nabel said in her statement, “The members of the NFL’s Head, Neck, and Spine Committee acted appropriately.”
The committee report said that Koroshetz disagreed with Miller’s characterization, and said he “was aware of no other instance where a donor raised objections to a grantee prior to the issuance of a notice of grant award.”
“The NFL’s characterization of the appropriateness of its actions suggests a lack of understanding of the importance of the NIH’s independent peer review process,” the committee report states.
Nabel’s spokeswoman said Koroshetz never told Nabel her actions were inappropriate. “In fact, all of their interactions were very collegial and cordial,” she said.
Arthur Caplan, a professor of bioethics at New York University, said Nabel’s actions, as described in the report, risk harming Nabel’s reputation and that of the Brigham. “When she did anything to try to shape the selection of investigators or challenge the objectivity” of the grant selection process, he said, “she had to know that that was 100 percent inappropriate, 100 percent unacceptable.”
On Tuesday, Ellenbogen sent a letter to members of the committee saying that the reports’ allegation that he “and others participated in an effort to influence an NIH grant selection process” could not “be further from the truth.” He said that he was not contacted by the committee staff.
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